This year, we will be fortunate if Grandma and Grandpa can join us at our holiday tables.
Perhaps unspoken during the meal is how frightening and costly it can be for older Americans to consider paying for long-term care services when independent living becomes too difficult, and how difficult it can become for the following generation to make sure their parents are taken care of in America.
Now is the time to begin dispelling rumours and embracing the new normal.
Contrary to popular belief, Medicare or health insurance do not cover long-term care expenses in the United States. In actuality, about one-third of long-term care costs in the United States are covered out of pocket; over 60% are covered by the public sector (mostly through Medicaid), but only if the patient has less than $3,000 in assets; and just roughly 4% are covered by private insurance.
In 2020, 7.5 million Americans possessed long-term-care insurance, according to the American Association for Long-Term Care Insurance.
The Department of Health and Human Services estimates that a person reaching 65 today has a nearly 70% likelihood of requiring long-term care services and support over their remaining years. There is a huge disparity between people in need of services and those who can afford them or who are eligible for Medicaid or certain long-term care benefits from the Veterans Administration.
Our children have to learn to deal with other new realities.
The age limit to be eligible for Old-Age, Survivors, and Disability Insurance was 65 when President Franklin D. Roosevelt signed Social Security into law in 1935. The majority of people who reached that age back then were uninsured and lived in poverty. 46 percent of adult males did not live to age 65 when benefits were first given out in 1940, and the average additional life expectancy for those who did was less than 13 years. It wasn’t much better for women. These Americans’ needs may be met by the system.
However, as individuals are living longer but not necessarily healthier lives, the burden on Social Security is higher now. “The experience of dying in the United States is often characterised by fragmented care, inadequate treatment of distressing symptoms, frequent transition among care settings, and enormous responsibilities for families,” state the National Academies of Sciences, Engineering, and Medicine.
What then can be done to make things right?
The United States ranks sixteenth among wealthy nations, according to a New York Times analysis of worldwide data that examined comparable wealthy nations, and spends 1 percent of its GDP on long-term care. According to the study, “Most spend more on government funding or insurance that people are legally compelled to get than the United States.” Certain safeguards prevent people from depleting all of their savings or income to cover long-term care expenses.
We may take our cues from a nation like Japan, where residents 40 years of age and older are required to carry long-term care insurance.
Alternatively, we may learn from the Netherlands, which in 2021 spent more than 4 percent of its GDP—four times more than the United States and more than any other nation monitored by the Organisation for Economic Cooperation and Development (OECD)—on long-term care.
Programmes like Social Security, Medicare, and Medicaid, which account for 46% of the government budget, could be reexamined. There might be more money available for long-term care if those programmes were restricted.
More state-level pilot programmes that offer alternatives to long-term care facilities can be established, and paid leave for employees to care for ageing family members can be promoted.
Ultimately, in order to prevent our children and grandkids from inheriting a mess, we need to have a national dialogue about ageing in America—a topic that goes beyond a delicious Thanksgiving dinner. With our part of the issue, it is the least we can do.
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